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Ibuprofen, COX-2 Inhibitors Increase Risk of Atrial Fibrillation


If you use painkillers such as ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) or COX-2 inhibitors to treat inflammation, you may be at increased risk of irregular heart rhythm, or atrial fibrillation. That’s the finding of a new study published in the latest edition of the British Medical Journal.

NSAIDs, COX-2 inhibitors increase heart attack risk

Atrial fibrillation is the most common rhythm disorder seen in clinical practice, according to the study’s authors, and its prevalence increases more than twofold each 10 years, from 0.5 percent at age 50 to 59 years to more than 10 percent in people ages 80 to 89. Before now, no study had explored whether NSAIDs and COX-2 inhibitors could increase the risk of this disorder.

The study population consisted of nearly 360,000 people living in Denmark: 32,602 patients diagnosed with atrial fibrillation between 1999 and 2008, and 325,918 age- and sex-matched controls. Investigators looked at their use of six commonly used painkillers: non-aspirin NSAIDS (ibuprofen, naproxen) and both older (diclofenac, etodolac) and newer (celecoxib, rofecoxib) COX-2 inhibitors.

Patients and controls were classified based on their use of NSAIDs and COX-2 inhibitors: no use, recent use, current use (those who got their first prescription within 60 days of their diagnosis), long-term use, and new use.

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The investigators found that patients who started treatment with non-aspirin NSAIDs were at greater risk of experiencing atrial fibrillation or flutter when compared with patients who did not use NSAIDs. The increased risk differed depending on the drugs used: there was about a 40 percent increased risk for those who used non-selective NSAIDs and 70 percent among those who used COX-2 inhibitors.

The research team, led by Professor Henrik Toft Sorensen at Aarhus University Hospital in Denmark, also identified certain groups at greatest risk for atrial fibrillation in the study. They included older people and patients with chronic kidney disease or rheumatoid arthritis who started treatment with COX-2 inhibitors.

Both non-selective NSAIDS and COX-2 inhibitors have been associated with a number of side effects (e.g., gastrointestinal problems) and serious long-term risks, including an increased chance of a stroke and heart attack. Atrial fibrillation has been linked to risks as well, including stroke, fainting, heart failure, and death.

Given the findings of this study, the authors concluded that “atrial fibrillation or flutter need to be added to the cardiovascular risks under consideration when prescribing NSAIDs.”

Schmidt M et al. British Medical Journal 2011; 343:d3450 doi: 10.1136/bmj.d3450